Challenging Seborrheic keratoses -- determining the clinical factors
that contribute to misdiagnosis
Abstract
Introduction & Objectives: Seborrheic keratoses (SK) are common
benign skin tumors that are typically easy to diagnose. However, some
SKs can be challenging and may be confused with malignant tumors. Our
objective was to identify clinical factors in the diagnosis and
management of SK Materials & Methods: A single-center,
retrospective, descriptive study was performed based on data between
2016 and 2022. A total of 365 cases with a conclusive histopathological
diagnosis of SK and complete clinical data were selected.
Results: In total, 146/365 (40%) were correctly diagnosed as SK.
The remaining 219/365 (60%) were mostly diagnosed as nevi, basal cell
carcinoma, squamous cell carcinoma and melanoma. The diagnostic
accuracy among physicians varied from 22% to 46%. For one physician,
age influenced the clinical diagnosis (p=0.039). In the non-SK group,
elderly patients had a tendency to have multiple excised lesions
(p=0.045). The COVID-19 pandemic did not significantly affect the
assessment criteria evaluated, except for the prioritization of larger
SKs in 2020 than those excised in 2019 (p=0.049). Head lesions
were more likely to have positive margins: 10/16 in the SK group vs 1/15
in the non-SK group (p=0.0052). The most common histological variant was
the hyperkeratotic SK observed in 28.5% of cases. No histological
variant had influence on the clinical diagnosis. Conclusion:
Although SK are benign, they can present a clinical challenge in
specific cases. Age, dimensions, experience and the number of lesions
should be carefully considered when excising a lesion. Exposed areas are
at risk of incomplete excisions.
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